Articles

The paper deals with the current tactics for managing epilepsy during pregnancy. Based on the data available in the literature and their extensive experience, the authors have developed and successfully introduced an observation scheme for pregnant women with epilepsy, stated contraindications for pregnancy, and determined the volume of clinical, laboratory, and instrumental studies, as well as observation frequency and the composition of specialists. Emphasis is placed on practical issues.

Vestibular rehabilitation is an important component of combination treatment in a patient with vertigo. Vestibular rehabilitation is indicated for different diseases of the central or peripheral vestibular system. The goal of vestibular rehabilitation is to ensure gaze stabilization, to train postural stability, and to reduce subjective vertigo. Vestibular rehabilitation is based on the stimulation of vestibular adaptation, sensory substitution, and habituation. Vestibular suppressants, inadequate mobility, anxiety, and depression decelerate vestibular compensation whereas early activation, mobility, and betaserc use accelerate it.

The paper presents current psychopharmacological approaches to therapy for depressions. It discusses the efficacy of depressants with a monoaminergic mechanism of action. Whether combination therapy with antidepressants and drugs from other pharmacological groups may be used is considered. Separate attention is paid to the agents whose antidepressant effect is unrelated to their action on the monoaminergic system.

The paper considers the clinical features and mechanisms of recovery of motor and cognitive functions after prior stroke. To treat stroke as soon as possible is emphasized to determine to a large extent the success of further rehabilitation measures. The most significant recovery is observed in the first 3 months after stroke; there may be generally only a slight worsening following 6 months. However, the recovery process may last longer in a number of patients. There are data on the use of nicergoline (Sermion®) in this category of patients.

The paper gives data on the prevalence, pathogenesis, and treatment of urinary incontinence in the elderly. There is a high rate of urinary incontinence among the patients who have experienced stroke or suffer from dementia or other neurological diseases. The ideas on the pathogenesis and manifestations of overactive bladder, stress urinary incontinence are outlined. Currently available drugs (anticholinergics, antidepressants, botulinum toxin preparations), methods for behavioral therapy and physiotherapy, and skin care in urinary incontinence are discussed. The current treatment options can improve quality of life in the elderly and their milieu.

Chronic alcoholic myopathy (CAM) is a common manifestation of alcoholic disease; however, the pathogenesis of the former has not been fully investigated. The main mechanism for the development of CAM is postulated to be impaired protein synthesis in the muscle fibers. A comprehensive clinical, biochemical, electromyographic, and morphological examination was made in 51 patients with chronic alcoholic intoxication. Morphological and morphometric studies were shown to play a determining role in the diagnosis of CAM. The clinical manifestations of skeletal muscle involvement corresponded to the magnitude of the atrophic process. Abnormalities were found in the basic components of protein synthesis at both the intracellular and systemic levels of regulation.

Dopamine dysregulation syndrome (DDS) is an iatrogenic disease developing during dopaminergic therapy. According to the data available in the literature, DDS develops in 3-4% of the Parkinson’s disease (PD) cases. DDS in PD is frequently accompanied by other impulse control disorders (ICD): punding, compulsive shopping, hypersexuality, overeating. 246 patients with PD, of whom 16 (6.4%) were found to have DDS, were examined. The patients’ age was 64±7.4 years. Women (n = 10) more often developed DDS than men (n = 6). The patients mainly suffered from the mixed form of the disease. Stages III and IV were diagnosed in 72 and 22%, respectively. The duration of PD was 12+2.6 years. In the PD patients with DDS, the quality-of-life indicators ranged from 19.8 to 90% (54+20.1%). The equivalent dose of levodopa is 1323.4+299 mg/day. DDS was concurrent with other types of ICD in 4 patients: panding in 2, compulsive shopping and punding in 1, and punding and hypersexuality. The doses of levodopa were corrected in patients receiving high doses of dopaminergic drugs. In the patients with DDS concurrent with punding or hypersexuality, the dose of dopaminergic receptor agonists was gradually reduced and subsequently discontinued.

Extended-release ropinirole is a new formulation of the well-known nonergolinic D2/D3 dopamine receptor agonist (DRAs), which has been widely used to treat Parkinson’s disease (PD) in foreign countries for many years. The efficiency of extended-release ropinirole (Requip Modutab) was evaluated in 12 patients with Hoehn-Yahr Stages I-IIPD who had not taken DRAs (n = 6) or had taken, but stopped their use no later than one month before their inclusion into the study (n = 6). The patients’ age was 38 to 72 years (mean 65.3+6.4 years); the disease duration was 1 to 4 years (2.1+1.8years). Six patients received amantadine, 4 had a fixed-dose of rasagi- line. The dose titration of Requip Modutab was 4 to 8 weeks. The starting dose of the drug was 2 mg/day in all the cases. Then it was increased once weekly until the optimal effect was achieved. The effective dose ranged 6 to 16 mg/day (mean 12.1+3.9 mg/day). The most common maintenance dose was 12 mg/day in 6 patients, 16 mg/day in 2, and 8 mg/day in 4. In 3 (25%) patients, the dose had to be decreased because of an adverse reaction. The total follow-up period was 8 months. When ropinirole was used, the average UPDRS (Parts II and II) scores decreased from 22.3+8.9 to 18.1+9.2 and 10.9+4.3 to 9.3+4.6, respectively (p < 0.05). Three (25%), 4 (33%), and 2 (17%) patients showed significant, moderate, and minimal improvement, respectively; 2 (17%) patients had no changes, worsening occurred in 1 (8%) patient. The achieved improvement was steadily maintained throughout the follow-up. Thus, Requip Modutab is an effective and safe agent for the treatment of early-stage PD, which assures an adequate control of motor disorders, on the one hand, and makes it possible to delay the use of levodopa or to be limited to its minimal dose, on the other hand, reducing the risk of fluctuations and dyskinesias. Once-daily use of the drug and a more convenient dose titration scheme create conditions for higher adherence to treatment and its higher efficiency.

The time course of changes in the parameters reflecting the status of different components of the body’s regulatory systems was studied in 125patients with hemispheric ischemic stroke via comprehensive evaluation of the hypothalamo-pituitary axes and some endocrine glands. There were three types of reactions of the body’s stress-regulating systems: 1) normergic; 2) hyperergic; 3) disergic, which characterized adaptive and disadaptive reactions in stroke. The changes in the nitroxydergic mechanisms of vascular tone regulation, which constrain the possible involvement of the vascular wall endothelium in the body’s adaptive reactions, progress as the condition becomes severe.

The paper describes cases that clearly demonstrate that the neurological status shows a preponderance of cognitive, emotional, and behavioral disorders in both cerebral vascular and neurodegenerative diseases just at the early stages. At the same time sleep disorders occupy the most important place among the behavioral disorders. So a neurologist must have advanced knowledge of this problem and practical skills in diagnosing neuropsychological disorders. Only consideration of all their clinical features allows the use of effective treatment that is able to improve the quality of life in a patient and his relatives, to prevent or delay the occurrence of severe complications.

The paper discusses the prevalence, clinical manifestations, and possibilities of treatment of moderate cognitive impairments (MCI). Criteria for the diagnosis of MCI are considered in detail. The evolution of views on MCI and the current ideas on this syndrome are described. Neuropsychologicalfeatures in MCI are detailed in relation to their etiology. The main lines of MCI treatment and the data of an interregional study of the efficacy of akatinol memantine in patients with MCI of varying etiology are given.

Arterial hypertension is regarded as an independent and most important risk factor for stroke and its most effective prevention is to lower elevated blood pressure (BP). International guidelines on and the results of large randomized placebo-controlled trials of different antihypertensive drugs used to prevent stroke are given. How to optimize the outpatient prevention of stroke is discussed. The preliminary results of the POWER trial evaluating the safety and efficacy of eprosartan, an angiotensin receptor blocker, in reducing BP are presented.

Lower back pain (LBP) is a serious health problem. Its main causes are described. It is noted that acute and chronic back pain may be a manifestation of any disease. Acute LBP is more frequently nonspecific and usually caused by injury or muscle strain of the back. Chronic pain is the result of the complex interaction of biological, psychological, social, and cultural factors; it may be nociceptive, neuropathic, inflammatory, dysfunctional, or mixed. The diagnosis of LBP is based by excluding its specific cause and requires the assessment of a patient’s complaints, history data and somatic and neurologic examination. The administration of analgesics or nonsteroidal anti-inflammatory drugs and myorelaxants is the main direction of drug therapy for LBP. Cognitive and behavioral psychotherapy along with other methods is one of the effective directions for patients with chronic LBP. The application of international guidelines for the management of patients with back pain permits a positive result to be achieved in most cases.

Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific) pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis) may be the drug of choice in the treatment of musculoskeletal pain.

Enteropathy induced by nonsteroidal anti-inflammatory drugs (NSAIDs) is a socially and clinically highly significant pathological process in terms of its epidemiology and consequences. Understanding of the seriousness of this problem requires that the occurrence and course of a pathological process in the small bowel should be controlled in the use of NSAIDs, on the one hand, and enables purposeful and pathogenetically sound prevention of NSAID-induced enteropathy on the other. At the same time, protection of not only the small bowel, but the entire digestive tube may be provided in full measure only when the protective potential of the mucosa is preserved. Coxibs, selective cyclooxygenase 2 inhibitors, that are safe for the digestive tubal mucosa, should be used as agents for the primary prevention of NSAID-induced injury.

The paper reviews the literature on bipolar affective disorder (BAD). It considers the diagnosis, course, and treatment of BAD with emphasis on maintenance pharmacotherapy to prevent disease recurrence and to improve quality of life in patients. Major drug classes both used to prevent recurrent BAD and promising agents whose effect on the course of affective diseases is being just tested are viewed.

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